President Bush today signed into law a President’s Emergency Plan for AIDS Relief re-authorised by Congress for five years with more than twice the funds used between 2003 and 2008, with a mandate to provide care and support to 12 million people by 2013.
The reauthorisation is vastly more than the White House requested, and is the result of a concerted campaign by advocates to extend the scope as well as the volume of US funding for AIDS relief. A total of $48 billion will be available over the next five years, of which $12.6 billion will go towards malaria and TB programmes. $2 billion could go to the Global Fund to Fight AIDS, TB and Malaria in 2009, a substantial increase in US support.
The bill, passed by both Democrat-controlled houses of Congress, removes the controversial requirement that one-third of prevention expenditure go to programmes that promote abstinence and faithfulness. Instead PEPFAR chiefs in countries with generalised epidemics will need to explain to Congress if they do not spend at least 50% of their prevention allocations on a broader range of interventions that promote abstinence, faithfulness, partner reduction and delayed sexual debut, which may still have the effect of biasing prevention activities towards extrenal targets rather than local realities.
The provision has been criticised by some advocates because it still falls short of comprehensive prevention programmes. Although the bill requires that prevention activities should address gender-based violence and legal protection for women and girls, it does not mention the importance of integrating family planning into HIV prevention activities.
On treatment no specific target is given for the numbers who should receive antiretroviral treatment, except to specify a minimum level of 2 million.Targets could fluctuate according to the level of appropriations in each year of the re-authorisation, making it difficult to plan ahead and creating a potential disincentive to recruit new patients onto treatment. The bill also sets down a target of 80% coverage of interventions to prevent mother-to-child transmission in the 15 PEPFAR focus countries.
The bill also contains an amendment inserted by the Senate that ends the ban on entry of HIV-positive people to the United States as visitors, refugees or asylum seekers. HIV-positive people will no longer be required to seek a special visa waiver through a US embassy abroad if they wish to visit the US, a decision that has been widely welcomed by advocates worldwide.